Basic Information
| Provider Information | |||||||||
| NPI: | 1154732519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHIPPLE | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | GRIFFIN | ||||||||
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| Credential: | MUSIC THERAPIST | ||||||||
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| OtherLastName: | GRIFFIN | ||||||||
| OtherFirstName: | KATIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5050 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752443995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005559073 | ||||||||
| FaxNumber: | 9723673452 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 W CAMPUS DR | ||||||||
| Address2: | BOX 091 | ||||||||
| City: | MILLEDGEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310611990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784455288 | ||||||||
| FaxNumber: | 4784453142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | MUT000005 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist |
No ID Information.